- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $460.90 / $460.90 / $7,397.00
| Facility | | $460.90 | $460.90 | $7,397.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,072.67 / $5,939.08 / $11,503.06
| Facility | | $2,072.67 | $5,939.08 | $11,503.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,125.53 / $1,596.96 / $3,841.70
| Facility | | $1,125.53 | $1,596.96 | $3,841.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.21 / $1,460.00 / $3,024.96
| Facility | | $1,023.21 | $1,460.00 | $3,024.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $462.89 / $808.45 / $3,991.00
| Facility | | $462.89 | $808.45 | $3,991.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,293.00 / $6,652.00 / $10,618.00
| Facility | | $3,293.00 | $6,652.00 | $10,618.00 |